A seizure is a pathological unregulated electrical discharge produced in the gray matter of the cerebral cortex and interrupts the normal brain function temporarily. A seizure typically causes an altered consciousness, paraesthesia, focal involuntary movements or convulsions (extended violent involuntary contraction of the muscles arbitrary). The diagnosis can be clinically and includes results of imaging, laboratory tests and EEG in new epileptic seizures or anticonvulsant levels for previously diagnosed seizure disorder. The treatment includes, if possible, eliminating the cause, anticonvulsants and surgery (if anticonvulsants are ineffective).

(Febrile seizures and Neonatal seizure syndromes.)

A seizure is a pathological unregulated electrical discharge produced in the gray matter of the cerebral cortex and interrupts the normal brain function temporarily. A seizure typically causes an altered consciousness, paraesthesia, focal involuntary movements or convulsions (extended violent involuntary contraction of the muscles arbitrary). The diagnosis can be clinically and includes results of imaging, laboratory tests and EEG in new epileptic seizures or anticonvulsant levels for previously diagnosed seizure disorder. The treatment includes, if possible, eliminating the cause, anticonvulsants and surgery (if anticonvulsants are ineffective). (Febrile convulsions and neonatal seizure syndromes.) About 2% of adults suffer at some point in their lives a seizure. Two thirds of these people have no other more. Definitions The terminology can be confusing. (also called epileptic seizure disorder) Epilepsy is a chronic disorder of the brain caused by (? 2), seizures that are not provoked (ie, they do not hang with reversible stressors together) and appearing at intervals of> 24 h, characterized , A single seizure is not considered an epileptic seizure. Epilepsy is often idiopathic, but various brain disorders such as malformations, insults and tumors can cause symptomatic epilepsy. Symptomatic epilepsy is epilepsy due to a known cause (z. B. brain tumor, stroke). The seizures caused thereby hot symptomatic epileptic seizures. Such attacks occur in newborns (neonatal seizure syndromes) and the elderly most often. Cryptogenic epilepsy is epilepsy, which is thought of that she has a particular cause, but which is currently unknown. Non Epileptic seizures are a temporary problem or a stressor (eg. As metabolic disorders, infections of the central nervous system, cardiovascular disorders, drug toxicity, or withdrawal, psychogenic disorders) provoked. In children, fever may provoke a seizure (febrile convulsions). Psychogenic non-epileptic seizures (PNEA, pseudo-seizures) are symptoms that mimic in patients with psychiatric disorders seizures, including but not heard any unusual electrical discharge in the brain. Etiology Common causes of seizures (see Table: Causes of seizures) vary depending on the age of onset: before 2 years of age: Fever, birth or developmental defects, birth trauma or metabolic disorders 2-14 years: idiopathic seizure disorder Adults: brain trauma, alcohol withdrawal, tumors, stroke, an unknown cause (50% of cases) Mature: tumors and stroke in the reflex epilepsy, a rare disease are triggered seizures predictable by an external stimulus, such. As by repetitive sounds, flashing lights, video games, music or even touching certain parts of the body. For the cryptogenic epilepsy and often for the refractory Eoilepsie a rare but increasingly recognized cause is the anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, v. a. at young women. This disorder also causes psychiatric symptoms, a movement disorder and pleocytosis. Ovarian teratoma occurs with Anti-NMDA receptor encephalitis in about 60% of women. Removal of teratoma (if any) and immunotherapy control the seizures much improved as anticonvulsants. Causes of seizures state examples autoimmune diseases cerebral vasculitis, anti-NMDA receptor encephalitis, multiple sclerosis (rarely) brain edema eclampsia, hypertensive encephalopathy Cerebral ischemia or hypoxia arrhythmia, carbon monoxide poisoning, drowning non-fatal, Beinaheersticken, stroke, vasculitis skull rauma * birth injuries, blunt or penetrating injuries CNS infections AIDS, brain abscess, falciparum malaria, meningitis, neurocysticercosis, neurosyphilis, rabies, tetanus, toxoplasmosis, viral encephalitis, congenital or developmental disorders Cortical malformations, genetic disorders (eg. B. Five days seizures †, lipid storage diseases such as Tay-Sachs disease), neuronal migration disorders (eg Heterotopien), phenylketonuria drug / drugs and toxins ‡ causing seizures. Camphor, ciprofloxacin, cocaine and other CNS stimulants, cyclosporin, imipenem, lead , pentylenetetrazol, picrotoxin, strychnine, tacrolimus decrease the seizure threshold: Aminophylline, antidepressants (especially tricyclic), sedating antihistamines, antimalarials, some antipsychotics (eg clozapine.), buspirone, fluoroquinolones, theophylline If the blood levels of phenytoin are very high, paradoxical increase in seizure frequency expansion intracranial lesions hemorrhage, hydrocephalus, tumors Hyperpyrexia drug / Arzneimittelzoxizität (eg. As amphetamines or cocaine), fever, heat stroke metabolic disorders Common, hypocalcemia (z. B. secondary to hypoparathyroidism), hypoglycemia, Hyponatriämiep Less commonly aminoacidurias, hepatic or uremic encephalopathy, hyperglycemia, hypomagnesemia, hypernatremia In newborns, vitamin B6 (pyridoxine) deficiency neurocutaneous disorder neurofibromatosis, tuberous sclerosis pressure-related decompression sickness, hyperbaric oxygen treatments withdrawal syndrome Alcohol, anesthetics, barbiturates, benzodiazepines * Post-traumatic seizures occur in 25-75% of patients with concussion, skull fracture, intracranial bleeding, andauerndem coma or focal neurological deficits. † Five days seizures (benign neonatal seizures) are tonic-clonic seizures, the old, otherwise healthy infants occur in 4-6 days; a mold is hereditary. ‡ administered in toxic doses, different medications may cause seizures. NMDA = N-methyl-d-aspartate. be division seizures as generalized or partially classified. Generalized Seizures In generalized seizures include the differing electrical discharge from the outset diffuse the entire cortex one. Consciousness is not usually receive. Generalized seizures are often the result of metabolic and sometimes genetic disorders. Generalized seizures include: Infantile spasms absence seizures Tonic-clonic seizures, tonic seizures, atonic seizures, myoclonic seizures (e.g., in juvenile myoclonic epilepsy.) Partial seizures in partial seizure takes the excessive neuronal discharge in the cortex in one hemisphere, and it results in most cases from structural changes. Partial seizures can be simple (no impairment of consciousness) complex (reduced, but not completely lost consciousness) Partial seizures can proceed in a generalized seizure (so-called. Secondary generalization), causing a loss of consciousness. A secondary generalization occurs if a partial seizure spreads and bilaterally activates the entire cerebrum. Activation can be done so quickly that the initial partial seizure is clinically silent or very short. A revised terminology for partial seizures was proposed [1]. In this system, partial seizures are called focal seizures, and the following terms are used for subtypes: In simple partial seizures: Focal seizures without impairment of consciousness or perception for complex partial seizures: focal seizures with impaired consciousness or awareness In secondary generalized partial seizures: partial seizures, which is located on a bilateral or seizure develop this terminology is not generally Gebrauch.Hinweis classification 1. Berg aT, Berkovic SF, Brodie MJ, et al: Revised terminology and concepts for organization of seizures and Epilepsies: Report of the ILAE [International League Against Epilepsy] Commission on Classification and Terminology, 2005-2009. Epilepsia51: 676-685, 2010. An aura symptoms and complaints. may precede seizures. Auras are simple partial seizures with focal onset. Auras can consist of motor activity or sensory, autonomic or mental sensations (z. B. paresthesia, a rising feeling from the stomach, strange smells, a sense of fear, déjà vu or jamais vu). When Jamais vu is a familiar place or an experience feels very strange to-as opposed to a sense of déjà vu. Most seizures terminate spontaneously within 1-2 min. A postictal state often follows generalized seizures. It is characterized by deep sleep, headache, confusion and aching muscles; This condition lasts minutes to hours. Sometimes the post-ictal state includes a Todd palsy (temporary neurological deficit, usually weakness of the contralateral to the seizure focus extremity). Most patients appear neurologically normal between attacks, although high doses of the drugs which are used for the treatment of seizure disorders, in particular, anticonvulsants, can reduce the vigilance. A progressive mental deterioration is usually attributed to more of a neurological disorder that causes seizures than the seizures themselves. Occasionally, the seizures do not remit, epilepticus as in status. Partial seizures There are several types of partial seizures. Simple partial seizures provoke motor, sensory or psychomotor symptoms without loss of consciousness. Specific symptoms reflect the affected brain area again (see table: manifestations of partial seizures on the location). In Jackson attacks the focal neurological symptoms begin in one hand, then they migrate up the arm (Jackson march). Other partial seizures, first affecting the face and then spread in one arm and one leg sometimes. Some partial motor seizures begin (so-called. Fechter position) with an arm lifting and turning the head to the upper arm. Manifestations of partial seizures by localization Focal manifestation localization of dysfunction Bilateral tonic posture frontal lobe (supplementärmotorischer cortex) Simple movements (eg. As twitching of limbs, Jackson-Marsch) contralateral frontal lobe head and gaze deviation with the posture Supplementärmotorischer cortex Abnormal taste sensation (dysgeusia) Insulation Visceral or autonomic abnormalities (eg. B. epigastric aura, salivation) Insulation-Orbitofrontalkortex olfactory hallucinations anteromedial temporal lobe chewing, salivation, speech blockage amygdala, Operculum Complex Verhaltensautomatismen temporal Unusual behavior indicates a psychiatric cause or sleep through the frontal lobe Visual Halluz Localized inationen (configured pictures) Posterior temporal lobe or amygdala-hippocampus sensory disturbances (eg. B. tingling or numbness of a limb or body) parietal lobe (sensory cortex) visual hallucinations (unformed images) occipital lobe epilepsia partialis continua is a rare disorder that causes focal motor seizures, which usually affect the arm, the hand or a side of the face; the seizures recur every few seconds or minutes for days or even years. The cause are mostly in adults: A structural lesion (eg stroke.). In children: A focal cerebral cortical inflammatory process (. Eg Rasmussen’s encephalitis), possibly caused by a chronic viral infection or by autoimmune processes. Tips and risks Pull partial seizures into account in patients with transient, unexplained, recurrent anomalies that seem to be psychiatrically (z. B. hallucinations, complex Verhaltensautomatismen, speech blockage, reduced responsiveness while the patient stares). Complex partial seizures is often preceded by an aura. patients can rigid during the seizure. The consciousness is impaired, but patients have a certain part of perception of the environment (eg. As they can carry out targeted defensive movements against painful stimuli). It may also occur following side effects. Oral automatism (involuntary chewing or smacking) automation in the extremities (eg. As automatic non-purposeful movements of the hands) manifestation of incomprehensible sounds without understanding what is had said opposition to support tonic or dystonic position of the limb contralateral to the seizure focus head and gaze deviation, usually in a direction contralateral to the seizure focus or cycling Strampelbewegungen the legs, when the attack from the medialofrontalen or orbitofrontal head areas can be seen, the motor symptoms disappear after one to two minutes, however, confusion and disorientation for another 1-2 minutes to pause. A postictal amnesia is common. Patients may lash out if they are hampered in their movements during the seizure or while they regain consciousness in generalized seizure. However Unprovoziertes aggressive behavior is unusual. Linkstemporale seizures can cause disorders of verbal memory; rechtstemporale seizures can visuospatial memory disorders verursachen.Generalisierte seizures Consciousness is extinguished, as a rule, and the motor functions are disturbed from the start. Infantile spasms are characterized by sudden flexion and adduction of the arms and forward flexion of the trunk. The attacks last from a few seconds and repeat several times a day. They only come during the 1st-5th Year of life before and are then replaced by other seizure types. There are developmental disorders usually. (Formerly called petit mal seizures) typical absence seizures consist of 10- to 30-second intervals with consciousness fluttering of the eyelids; the axial muscle tone may, but need not be lost. Patients plunge or not cramp; they abruptly stop their activity and then take them as abruptly again, without post-ictal symptoms or the knowledge that a seizure has occurred. Absence seizures are genetic and are mainly found in children. Without treatment, these attacks often repeated many times a day. The attacks often occur when patients sit quietly, they can be provoked by hyperventilation and rarely occur during physical exertion. Neurological and cognitive test results are usually normal. Atypical absence seizures usually occur as a part of the Lennox-Gastaut syndrome, a severe form of epilepsy that begins before the age of 4. They differ from typical absence seizures as follows: they last longer. Jerk fashion movements or Bewegungsautomatismen are more pronounced. The loss of consciousness is less complete. Many patients have a history of lesions of the nervous system, developmental delays, abnormal neurological examination results and other forms of epilepsy. Atypical absence seizures are usually continue into adulthood. Atonic seizures are most common in children, usually as part of the Lennox-Gastaut syndrome. Atonic seizures are characterized by a short, total loss of muscle tone and consciousness. The children fall, or fall to the ground, with the risk of trauma, v. a. Head injuries. Tonic seizures often occur during sleep, usually in children. Cause is the Lennox-Gastaut syndrome usually. Tonic (persistent) contractions axial muscles put an abrupt or gradual, then they spread out to the proximal extremity muscles. Tonic seizures usually last from 10 to 15 s. For longer tonic seizures few very fast clonic spasms in the late tonic phase may occur. Tonic-clonic seizures may be primarily generalized secondarily generalized primary generalized seizures typically begin with an initial cry; then the patient loses consciousness and falls, followed by tonic contractions, then clonic movements (fast alternating contraction and relaxation) of the extremities, trunk and head muscles. Urine and fecal incontinence, tongue biting and foaming at the mouth occur sometimes. The attacks usually last for 1-2 min. There is no aura. Secondary generalized tonic-clonic seizures begin with a simple or complex partial seizures and then are progressing and are similar to other generalized seizures .. Myoclonic seizures are brief, lightning-like jerks of a limb, several limbs or torso. You can be repetitive and lead to a tonic-clonic seizure. The spasms may occur on one or both sides. Unlike other convulsions with bilateral motor movements consciousness is not lost unless the myoclonic goes into a generalized tonic-clonic seizure. Juvenile myoclonic epilepsy is an epilepsy syndrome, which is characterized by myoclonic, tonic-clonic and absence seizures. They typically occurs during adolescence. The seizures begin with a few bilateral, synchronous myoclonic jerks, in 90% of cases, followed by generalized tonic-clonic seizures. They often occur when the patient wakes up in the morning, especially after sleep deprivation or alcohol use. Absence seizures can occur in one third of patients. Febrile seizures are defined as before with fever and without the presence of intracranial infection; they are (a seizure provocation) viewed as a kind of opportunity attack. They affect about 4% of children aged between 3 months and 5 years. Benign febrile seizures are short, occur only once, are generalized and look like a tonic-clonic seizure. Complex febrile seizures are focal, last> 15 min or contact ? 2 times on at <24 h. A total of 2% of patients develop a subsequent seizure disorder with febrile seizures. However, the incidence of seizure disorders and the risk of recurrent febrile seizures is much greater in children with any of the following: Pre-existing Complicated febrile seizures neurological abnormalities start: Before the first year of life a family history of seizures. Status epilepticus Status epilepticus has two forms: convulsively and nichtkonvulsiv. The generalized convulsive status epilepticusumfasst least one of the following: Duration of tonic-clonic seizure activity> 5-10 min ? 2 seizures between which patients do not fully regain consciousness, the former definition with a duration> 30 min in terms of a faster diagnosis and treatment revised. Untreated generalized seizures with a duration> 60 minutes can lead to permanent damage to the brain; Prolonged attacks can be fatal. Heart rate and temperature increase. A generalized status epilepticus has many causes, including head injuries and very fast settling of anticonvulsant drugs. The nichtkonvulsive Status epilepticus includes an complex partial status epilepticus and a status epilepticus Absence. They often manifest as prolonged episodes of changes in mental status. To help diagnose an EEG may be needed. Diagnosis Clinical evaluation In new-onset seizures neuroradiological imaging, laboratory tests and generally EEG For known seizure disorders usually determine the anticonvulsant levels In newly occurring or known seizure disorders further tests as clinically indicated In the evaluation must be determined whether the event was a seizure or another cause was (for. example pseudo seizures, syncope), then possible causes or favorable factors must be identified. Patients with new-onset seizures are examined in the emergency room; sometimes they can be released after a thorough investigation. Patients with a known seizure disorder can be an outpatient basis in a practical diagnostic work up. Medical history, patients should be asked about unusual sensations typical of an aura and speak a seizure and seizure manifestations. Patients do not remember a rule of generalized seizures, so a description of the actual seizure of witnesses must be obtained. Manifestations of other disorders such. As a sudden global ischemia in the brain (eg. As a result of ventricular arrhythmia) can resemble those of a seizure, incl. Loss of consciousness and some myoclonic jerks. Tips and risks Pull in people who suddenly lose consciousness, a global ischemia in the brain (eg. As a result of ventricular arrhythmia) into consideration, although observers report myoclonic jerks. The medical history should include information about the first and each subsequent seizure included (z. B. duration, frequency, order of appearance of symptoms, the longest and shortest interval between seizures, aura, postictal state, favorable factors). All patients should be questioned about risk factors for seizures. Former head trauma or CNS infection known neurological disorders drug use or withdrawal, particularly of recreational drugs alcohol withdrawal do not observe the Antikonvulsivaeinnahme family history of seizures or neurological disorders Patients should also for rare triggers (eg. As repeated sounds, flashing lights, video games, touching certain body parts) are asked and after sleep deprivation, which the seizure threshold lowering kann.Körperliche study in patients who have lost consciousness, suggest a tongue biting, incontinence (eg., urine or feces in clothing) or persistent confusion to loss of consciousness to a seizure. In pseudo seizures generalized muscular activity and the lack of response to verbal stimuli at first glance generalized tonic-clonic seizures may suggest. However, pseudo-seizures can usually distinguish from real seizures based on clinical features: pseudoseizures often take longer (several minutes or longer). A post-ictal confusion rather lacking. The typical activity pattern in which a tonic phase, clonic phase follows, not reflected in the rule. The progression of muscle activity does not correspond to real attack patterns (z. B. spasms, which increased from one side to the other and running back [non-physiological progression], pelvic movements). The intensity can increase and decrease again. Vital signs, incl. Temperature, usually remain normal. Patients often defend themselves active against passive eye opening. In idiopathic seizures physical examination often shows the cause, but it can provide significant information when it is symptomatic seizures (see Table: Clinical clues to the causes of symptomatic seizures). Clinical evidence of the causes symptomatic seizures findings Possible causes fever and neck stiffness meningitis meningoencephalitis subarachnoid hemorrhage papilledema Increased intracranial pressure lack of spontaneous venous pulsations Increased (in Funduscopy lockable) intrakanieller pressure (specificity 80-90% *) Focal neurolog ical deficits (eg. B. asymmetry of reflexes or muscle force) structural anomaly (for. Example, tumor, stroke) Postictal paralysis Generalized neuromuscular irritability (z. B. tremors, hyperreflexia) drug toxicity (z. B. sympathomimetics) withdrawal symptoms (eg. As alcohol or sedatives ) Bestimmte Stoffwechselerkrankungen (z. B. Hypokalzämie, Hypomagnesiämie) Hautläsionen (z. B. Flecken am Rumpf oder Café-au-lait-Flecken, hypopigmentierte Hautflecken, Chagrin-Flecken) Neurokutane Erkrankungen (z. B. Neurofibromatose, tuberöse Sklerose) * Spontane venöse Pulsa tionen fehlen bei allen Patienten mit erhöhtem Hirndruck; the


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